Bone fixation plate system and method

ABSTRACT

A fastener, for example a bone screw, is sized to pass through a hole of an implant, for example a bone plate, the fastener having a shaft or anchor portion engageable with body tissue, and a head portion. A locking cap secures to the bone plate and covers the head to block the head and inhibit screw back out. Alternatively, or additionally, a locking disc located in the plate hole resiliently deflects downward to allow screw insertion, but is blocked to limit or prevent upward deflection so that screw back out is inhibited.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/211,761, filed Aug. 17, 2011, which is incorporated by referenceherein in its entirety for all purposes.

FIELD OF THE INVENTION

The invention relates to a bone fixation system and method.

BACKGROUND OF THE INVENTION

Bones may be reinforced with rigid structures, for example plates,having apertures through which bone screws may pass. Such reinforcing isuseful for addressing fractures or other trauma, correcting alignment,or treating disease. A bone plate is used to span a fracture, or to joindifferent bones. It is important that a bone screw securing a bone platedoes not loosen and separate from the plate postoperatively. Thisseparation or backing out is typically a result of the failure toachieve sufficient screw thread purchase in the bone, although strippingof the screws has also been known to cause this problem. Regardless ofthe cause of the hardware failures, a surgeon must repair or replace thebroken parts, requiring an undesirable invasive procedure.

Devices for preventing this separation may be associated with the plateand/or screw. Examples include a cover positioned over all or part ofthe screw head, or an expansion-head screw.

SUMMARY OF THE INVENTION

The present invention relates to a bone plate fixation system thatcomprises a bone plate having an upper surface, a bone-contactingsurface, and a hole defined by a wall and passing through the upper andbone-contacting surfaces; a locking disc inserted into the hole andengaging at least a portion of the wall of the hole; and a bone screwfor fixing the bone plate with respect to a bone. The bone screw isinsertable through the hole into bone in an insertion direction to fixthe bone plate to the bone and the locking disc is operativelyassociated with the wall to resist resilient deflection of the lockingdisc in the insertion direction of the bone screw less than the lockingdisc resists resilient deflection of the locking disc in a directionopposite the insertion direction.

The wall of the bone plate hole can have a groove configured anddimensioned to receive the locking disc. The locking disc can becooperatively received in the groove such that the groove permitsresilient deflection of the locking disc in only the insertion directionof the bone screw.

The plate hole can be provided with an entrance near the upper surfaceof the bone plate that is chamfered to facilitate insertion of the bonescrew. The plate hole can also be provided with an exit near thebone-contacting surface, with a spherical portion extending upward fromthe exit toward entrance. In one embodiment, the plate hole flaresoutward from the spherical portion to the groove. The lower portion ofthe groove can be a tapered section that creates a gap between aninferior aspect of the locking disc and the groove, thereby allowingresilient deflection of the locking disc. A superior aspect of thelocking disc can be flush with an upper portion of the groove, therebyinhibiting resilient deflection of the locking disc.

The present invention also relates to a bone plate fixation system thatcomprises a bone plate having an upper surface, a bone-contactingsurface, and a hole defined by a wall and passing through the upper andbone-contacting surfaces, with the wall including a track. A locking caphaving a first tab is insertable in the track in an insertion positionin which the locking cap can be inserted in a vertical direction intothe track and movable to a locked position in which the locking cap issubstantially fixed with respect to the track in the vertical directionto inhibit back out of a bone screw inserted in the plate hole.

The bone plate can include a first slot that extends from the upperbone-contacting surface to the track, with the first slot configured anddimensioned to receive the first tab such that the locking cap can bemoved from a location external to the bone plate into the track in theinsertion position. The locking cap can include a central aperture, thecentral aperture allowing access to at least a portion of a head of abone screw inserted or being inserted in the plate hole.

In an exemplary embodiment, the central aperture is configured anddimensioned to receive a tool, the tool operative to move the lockingcap between the insertion and locked positions.

The locking cap can have an inferior surface that includes a chamferthat allows angulation of a screw inserted into the plate hole at anangle, including an angle other than perpendicular with respect to thebone plate. The track can extend completely around the wall or

only partially around the wall, in two or more discrete portions.

The first tab can be operatively received in the track such that whenthe locking cap is moved to the locked position, at least one oftactile, auditory, and visual feedback is provided to indicate that thelocking cap is in the locked position. In this regard, the track caninclude a protrusion and the first tab can include a recess, with theprotrusion engaging the recess when the locking cap is moved to thelocked position to provide tactile feedback that the locking cap is inthe locked position.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete understanding of the present invention, and theattendant advantages and features thereof, will be more readilyunderstood by reference to the following detailed description whenconsidered in conjunction with the accompanying drawings wherein:

FIG. 1 depicts a perspective exploded view of an embodiment of the bonefixation plate system according to the present invention.

FIG. 2 shows a cross sectional view of the bone screw hole of FIG. 1.

FIG. 3 shows a perspective view of the locking disc of FIG. 1.

FIG. 4 shows a cross sectional view of the locking disc and bone screwhole with the bone screw not inserted.

FIG. 5 shows a cross sectional view of the locking disc and bone screwhole with the bone screw fully seated in the bone screw hole.

FIG. 6 is a perspective view of another embodiment of the bone fixationplate system according to the present invention, showing a portion of abone plate and a locking cap prior to insertion.

FIG. 7 shows a cross sectional view of the bone plate of FIG. 6 throughline 7-7.

FIG. 8 shows a cross sectional view of the bone plate of FIG. 6 throughline 8-8.

FIGS. 9A and 9B show perspective views of the top and bottom of thelocking cap of FIG. 6.

FIG. 10 shows a side view of the locking cap.

FIG. 11 shows a top view of the locking cap.

FIG. 12 shows a cross sectional view of the locking cap through line11-11.

FIG. 13 shows the locking cap inserted in a plate hole.

FIG. 14 shows the locking cap inserted in the plate hole rotated to apartial locked position.

FIG. 15 shows the locking cap inserted in the plate hole rotated to alocked position.

FIG. 16 shows a cross sectional view of a bone screw in the plate holewith the locking cap.

DETAILED DESCRIPTION OF THE INVENTION

In the description which follows, any reference to direction ororientation is intended primarily and solely for purposes ofillustration and is not intended in any way as a limitation to the scopeof the present invention. Also, the particular embodiments describedherein are not to be considered as limiting of the present invention.

Fixation systems are disclosed, advantageously utilized with an implant,for example a joining member such as a plate having a fastener or screwhole, though which an anchor portion of a fastener may pass, but not thefastener head. A locking mechanism inhibits the fastener from coming outof the joining member. The implant may have any shape or purpose, andmay include, for example, plates, rods, bars, joint replacements, orother anchoring members, and may be used to join body tissues anywherein the body.

The term “backing out” or “back out” herein refers to movement of afastener of the disclosure from a position inserted within body tissue,along a direction reversed with respect to a direction of insertion,whereupon the fastener may be caused to exhibit a reduced fasteningeffect. Back out may be caused by micromotion, disease including tissuedegradation, trauma, or other causes.

Clinical applications for the instant disclosure include, but are notlimited to, stabilizing any vertebrae, for example cervical, thoracic,lumbar, or sacral vertebrae; joining bone fractures; joining softtissue, for example tendons or ligaments, to bone; or any procedurehereinafter developed, which advantageously benefits from a reliableanchor connection, and particularly for a screw anchor connection.

Turning now to the drawings, in which like reference numerals refer tolike elements, FIG. 1 shows one embodiment of a bone fixation platesystem 100 including a bone plate 102 having a plate hole 104 forreceiving a fastener or bone screw 106 which engages body tissue,typically bone, to thereby fix bone plate 102 to the bone tissue. Alocking disc 108 is located in hole 104, with bone screw 106 insertablethrough hole 104 into bone in an insertion direction to fix bone plate102 to the bone. As set forth in more detail below, locking disc 108 isoperatively associated with plate hole 104 to resist resilientdeflection in the insertion direction of bone screw 106 less thanlocking disc 108 resists resilient deflection in a direction oppositethe insertion direction to thereby inhibit back out of bone screw 106.

FIG. 1 shows bone plate 102 having a generic configuration. The presentinvention contemplates that bone plate 102 can be provided with aconfiguration suitable for a particular clinical application. Forexample, if bone plate fixation system 100 is to be used in the cervicalspine, bone plate 102 can have a configuration like the plates disclosedin U.S. Pat. No. 7,963,981, the content of which is incorporated hereinby reference.

Although only one bone plate screw hole 104 is shown, bone plate 102 canbe provided with any number of plate holes to suit the intended clinicalapplication, with each plate hole capable of receiving a bone screw. Inthis regard, the plate hole can be provided with or without a lockingdisc 108. In other words, the present invention contemplates a boneplate having one or more bone plate screw holes, with one or more of theplate holes provided with a locking disc to inhibit screw back out.

Bone plate 102 has an upper surface 110 and an opposite bone-contactingsurface 112, which in use contacts bone or other body tissue to whichbone plate 102 is to be fixed. Bone plate screw hole 104 passes throughupper 110 and bone-contacting 112 surfaces. As shown in FIG. 2, boneplate screw hole 104 is defined by a wall or periphery and has anentrance 114 that can be advantageously chamfered to facilitateinsertion of bone screw 106. Plate hole 104 additionally includes areduced dimension located on an opposite end to entrance 114, at an exit116, operative (in conjunction with the configuration and dimensions ofthe rest of plate hole 104 relative to the configuration and dimensionsof bone screw 106) to limit the extent bone screw 106 is insertable intoplate hole 104.

Plate hole 104 has a spherical portion 118 extending upward from exit116 toward entrance 114. As set forth in more detail below, preferablythe spherical portion may accommodate a bone screw having a sphericalhead. However, the present invention is not limited to sphericalcurvatures or spherical heads. In other embodiments, any complementaryhead and receptacle may be used. Plate hole 104 flares outward fromspherical portion 118 to a groove 120 which is configured anddimensioned to receive locking disc 108. The outward flaring providesthe lower portion of groove 120 with a tapered section 122.

FIG. 3 shows locking disc 108 is shaped like an o-ring. The innersurface can be provided with one or more cutouts 124 to facilitateinsertion and removal of locking disc 108. Advantageously, the cutouts124 provide flexibility to the locking disc 108, and in particular,allow the locking disc 108 to flex downward toward bone but not upwards.As shown in FIG. 3, the locking disc 108 includes four cutouts 124distributed at equal distances from each other around the locking disc108. In this regard, locking disc 108 can be provided pre-assembled inplate hole 104 or the surgeon can insert locking disc 108 into platehole 104. Either way, the surgeon can selectively insert or removelocking disc 108 from a given plate hole 104. Although locking disc 108is shown as forming a complete circle, locking disc 108 need not extenda full 360°, so that only a portion of a circle is formed. An outersurface 126 of locking disc 108 can be curved to mate with groove 120.When bone screw 106 has a spherical head, an inner surface 128 can alsobe curved to facilitate insertion of bone screw 106.

As shown in FIG. 4, when locking disc 108 is inserted in plate hole 104,locking disc 108 fits snugly in groove 120. In the superior aspect,there is little or no space between groove 120 and locking disc 108.This minimizes or reduces resilient upward deflection of locking disc108 to inhibit screw back out. In the inferior aspect, tapered section122 of groove 120 results in a space or gap 130, which provides fordownward resilient deflection of locking disc 108 as bone screw 106 isbeing inserted into plate hole 104. Thus, advantageously, screw 106 canbe inserted downwardly by overcoming the resilient force of the lockingdisc 108, but will have sufficient counterforces to prevent back out ofthe screw 106 once it is inserted.

FIGS. 1 and 5 show bone screw 106 has a head portion 132 and a shaftportion 134 and may be passed into a preformed opening in body tissue,or may form or expand an opening in body tissue by self drilling and/orself tapping. At least a portion of shaft 134 is provided with a threador threads 136 to engage body tissue, for example cortical bone,cancellous bone, tendinous, ligamentous, or other body tissue capable ofbeing securely engaged by threads. Head 132 is provided with toolengagement means, for example a Phillips, hex, or other engagementprofile 138, whereby a tool may be used to position and or drive screw106 into engagement with bone plate 102 and into body tissue. Althoughhead 132 is shown as a spherical head, the present invention is notlimited to spherical curvatures or spherical heads as previously noted.In other embodiments, any complementary head and receptacle may be used.

Bone plate 102 and bone screw 106 may be comprised of any material, suchas a metal, alloy, or any combination of the two. The material used ispreferably bio-compatible and capable of withstanding the conditions ofa body over a desired period of time. In some embodiments, this isachieved by manufacturing plate 102 and screw 106 using a metallicmaterial such as titanium or stainless steel. Titanium has sufficientductility to permit a desired amount of curving of plate 102 if need be(e.g. to conform to the shape of the vertebrae) yet has the strength tomaintain its structural integrity.

Locking disc 108 may be comprised of any material, such as a metal,polymer, composite, or any combination of the three. The material usedis preferably bio-compatible and capable of withstanding the conditionsof a body over a desired period of time. In some embodiments, this isachieved by manufacturing locking disc 108 using material such astitanium or any medical grade polymer.

Referring principally to FIG. 5, in use screw 106 is inserted into platehole 104 in an insertion direction 140. As a result of the resiliency oflocking disc 108 and space or gap 130, locking disc flexes downward(i.e. in insertion direction 140) as bone screw 106 is being insertedinto plate hole 104. In the embodiment shown, there is preferably anincrease in resistance to resilient deflection of locking disc 108 asbone screw 106 is being inserted into plate hole 104 until the largestdiameter of the generally spherically shaped head 132 of bone screw 106contacts locking disc 108. Once the largest diameter of head 132 reacheslocking disc 108, the resistance to downward deflection of locking disc108 begins to decrease. This change in resistance advantageouslyprovides tactile feedback to the surgeon that bone screw 106 issufficiently seated. Visual feedback can also be provided in that itwill be evident when bone screw 106 is above locking disc 108 and istherefore not sufficiently seated.

As a result of the snug fit in the superior aspect of locking disc 108into groove 120, resilient upward deflection of locking disc 108 isminimized or reduced to inhibit screw back out in an opposite direction142 with respect to insertion direction 140. Screw 106 may be screwedinto bony tissue at any desired angle. In other words, screw 106 doesnot have to be inserted perpendicular to plate 102.

FIGS. 6-16 show another embodiment of a bone plate system 200 accordingto the present invention, which, as set forth in more detail below, canprovide tactile, visual, and/or other feedback to the surgeon that alocking mechanism is engaged to inhibit back out of a bone screw.

As shown in FIGS. 6-8, bone fixation plate system 200 includes a boneplate 202 having a plate hole 204 for receiving a fastener or bone screw206 (FIG. 16) which engages body tissue, typically bone, to thereby fixbone plate 202 to the bone tissue. A locking cap 208 is located in hole204, with bone screw 206 insertable through hole 204 into bone in aninsertion direction to fix bone plate 202 to the bone. As set forth inmore detail below, locking cap 208 is inserted into screw hole 204 andthen moved to a locked position in which locking cap is substantiallyfixed with respect to screw hole 204 to inhibit back of a bone screwinserted in plate hole 204.

Bone plate 202, like bone plate 102, can be provided with aconfiguration suitable for a particular clinical application. Althoughonly two bone plate screw holes 204 are shown, bone plate 202 can beprovided with any number of plate holes to suit the intended clinicalapplication, with each plate hole capable of receiving a bone screw. Inthis regard, the plate hole can be provided with or without a lockingcap 208. In other words, the present invention contemplates a bone platehaving one or more bone plate screw holes, with one or more of the plateholes provided with a locking cap to inhibit screw back out.

Bone plate 202 has an upper surface 210 and an opposite bone-contactingsurface 212, which in use contacts bone or other body tissue to whichbone plate 202 is to be fixed. Bone plate screw hole 204 passes throughupper 210 and bone-contacting 212 surfaces. Bone plate screw hole 204 isdefined by a wall or periphery 213 and has an entrance 214 that can beadvantageously chamfered to facilitate insertion of bone screw 206.Plate hole 204 additionally includes a reduced dimension located on anopposite end to entrance 214, at an exit 216, operative (in conjunctionwith the configuration and dimensions of the rest of plate hole 204relative to the configuration and dimensions of bone screw 206) to limitthe extent bone screw 206 is insertable into plate hole 204. In thisregard, plate hole 204 can have a spherical configuration extendingupward from exit 216 toward entrance 214. Preferably the sphericalportion may accommodate a bone screw having a spherical head. However,the present invention is not limited to spherical curvatures orspherical heads. In other embodiments, any complementary head andreceptacle may be used.

A first slot 218 a and a second slot 218 b extend from upper surface 210to a track 220 located on wall 213 of plate hole 204. Slots 218 a and218 b allow locking cap 208 to be inserted into plate hole 204. Althoughtwo slots are shown, the number and shape of slots 218 a and 218 b canbe selected based on the configuration of locking cap 208. Althoughtrack 220 is shown as extending completely (i.e. 360°) around wall 213,track can extend only partially around wall 213. In an exemplaryembodiment, track 220 comprises two discrete portions with first slot218 a providing access to the first portion of track 220 and second slot218 b providing access to the second portion of track 220. As best seenin FIG. 8, track 220 has a first protrusion 222 a and a secondprotrusion 222 b, which will be described below in further detail.

Referring now primarily to FIGS. 9-12, locking cap 208 has a first tab224 a and a second tab 224 b. First tab 224 a is insertable in track 220(via either one of first and second slots 218 a, 218 b) in an insertionposition in which locking cap 208 can be inserted in a verticaldirection into track 220 and movable to a locked position in whichlocking cap 208 is substantially fixed with respect to track 220 in thevertical direction to inhibit back out of a bone screw inserted in platehole 204. Similarly, second tab 224 a is insertable in track 220 (viathe other of first and second slots 218 a, 218 b) in an insertionposition in which locking cap 208 can be inserted in a verticaldirection into track 220 and movable to a locked position in whichlocking cap 208 is substantially fixed with respect to track 220 in thevertical direction to inhibit back out of a bone screw inserted in platehole 204. In some embodiments, the first slot 218 a and second slot 218b are configured differently such that first tab 224 a is configured tofit in first slot 218 a, while second tab 224 b is configured to fit insecond slot 218 b. In other embodiments, first tab and second tab 224 aand 224 b can fit in either of first slot and second slot 218 a and 218b.

Locking cap 208 can include a central aperture 226 that allows access toat least a portion of a head of a bone screw inserted or being insertedin plate hole 204. This provides for adjustment of screw insertion evenwith locking cap 208 positioned in plate hole 204. Central aperture 226can be configured and dimensioned to receive a tool operative to movelocking cap 208 between the insertion and locked positions. In thisregard, FIG. 11 shows central aperture 226 with wings 228 engageable bya tool such as a slotted screwdriver for rotating or twisting lockingcap 208 into or out of the insertion and locked positions. Otherconfigurations are contemplated by the present invention.

As was the case for bone plate 102, a bone screw may be screwed intobony tissue at any desired angle. In other words, the bone screw doesnot have to be inserted perpendicular to plate 202. Locking cap 208 canhave an inferior surface 230 that includes a chamfer 232 to accommodateangulation of a screw inserted into plate hole 204 at an angle otherthan perpendicular with respect to bone plate 202.

One or both tabs 224 a, 224 b can have a recess 234, which cooperateswith protrusions 222 a, 222 b to provide tactile feedback that lockingcap 208 is in the locked position. In particular, as locking cap 208 isrotated from the insertion position, recess 234 on one of tabs 224 a,224 b engages one of protrusion 222 a, 222 b in track 220. The change inresistance to rotation provides tactile feedback that locking cap 208 isin the locked position. The engagement of recess 234 with protrusion 222a or protrusion 222 b can also reduce the possibility that locking cap208 unintentionally moves from the locked position to the insertionposition, thereby further inhibiting back out of a bone screw.

The cooperation of locking cap 208 and plate hole 204 will be discussedfurther with reference to FIGS. 13-15, which have the bone screw omittedfor simplicity. As shown in FIG. 13, tab 224 a is aligned with slot 218a and tab 224 b is aligned with slot 218 b when locking cap 208 is inthe insertion position. Because of this alignment, locking cap 208 canbe inserted in a vertical direction into track 220. In FIG. 14, lockingcap 208 is rotated in track 220 so that a portion of tab 224 a is nolonger aligned with slot 218 a and a portion of tab 224 b is no longeraligned with slot 218 b. As a result, locking cap 208 is substantiallyconfined in the vertical direction thereby limiting back out of a bonescrew inserted in plate hole 204.

As locking cap 208 is further rotated in track 220, recess 234 on tab224 a engages protrusion 222 a and recess 234 on tab 224 b engagesprotrusion 222 b, providing tactile feedback that locking cap 208 is inthe locked position. The engagement of tabs 224, 224 b with recesses 234may also provide audible feedback. In addition to, or in lieu of tactileand/or audible feedback, visual feedback can be provided to confirmlocking cap 208 is in the locked position. An example of visual feedbackis shown in FIG. 15 in which wings 228 on locking cap 208 are positionedapproximately 90° from slots 218 a, 218 b. Locking cap 208 and/or boneplate 202 can be provided with other indicia, such as etching or othermarkings, to indicate the insertion and/or locked positions.

As previously noted, the number of tabs of locking cap 208 is notlimited to two and bone plate hole 204 can be provided with acorresponding number of slots. In this regard, the present inventioncontemplates that bone plate hole 204 is provided with more slots thanlocking cap 208 is provided with tabs. As shown in the figures, lockingcap 208 can rotate in either direction within track 220 between theinsertion position and the locked position. However, locking cap 208and/or track 220 can be configured and dimensioned and arranged so thatrotation in one direction is needed to move from the insertion positionto the locked position and rotation in the opposite direction is neededto move from the locked position to the insertion position.

FIG. 16 shows bone screw 206 seated in plate hole 204 with locking cap208 inhibiting back out of bone screw 206 by physically blocking orotherwise interfering with backward movement of bone screw 206. Bonescrew 206 can be substantially similar to, if not identical to, bonescrew 106. Accordingly, reference is made to the description of bonescrew 106. Bone screw 206 has a head portion 236 and a shaft portion 238and may be passed into a preformed opening in body tissue, or may formor expand an opening in body tissue by self drilling and/or selftapping. At least a portion of shaft 238 is provided with a thread orthreads 240 to engage body tissue, for example cortical bone, cancellousbone, tendinous, ligamentous, or other body tissue capable of beingsecurely engaged by threads. Head 236 is provided with tool engagementmeans, for example a Phillips, hex, or other engagement profile 242,whereby a tool may be used to position and or drive screw 206 intoengagement with bone plate 202 and into body tissue. Although head 236is shown as a spherical head, the present invention is not limited tospherical curvatures or spherical heads as previously noted. In otherembodiments, any complementary head and receptacle may be used.

Bone plate 204, bone screw 206, and locking cap 208 may be comprised ofany material, such as a metal, alloy, or any combination of the two. Thematerial used is preferably bio-compatible and capable of withstandingthe conditions of a body over a desired period of time. In someembodiments, this is achieved by manufacturing plate 202, screw 206, andlocking cap 208 using a metallic material such as titanium or stainlesssteel. Titanium has sufficient ductility to permit a desired amount ofcurving of plate 202 if need be (e.g. to conform to the shape of thevertebrae) yet has the strength to maintain its structural integrity.

In use, bone plate 202 is positioned in a therapeutic location in thebody, and body tissue is approximated or otherwise positioned to bestabilized. Bone screw 206 may be positioned through plate hole 204before or after connecting a tool, after which the tool is used toengage bone screw 206 with body tissue. Once bone screw 206 has beeninserted sufficiently through plate hole 204 so that head portion 236 ofbone screw 206 is below track 220, locking cap 208 can be positioned intrack 220 if desired and if tool is configured to pass through centralaperture 226 of locking cap 208 to allow further tightening. Locking cap208 can remain in the insertion position or could be moved to the lockedposition or a position therebetween. Seating of the bone screw 206 isthen completely and if not previously done so, locking cap 208 is movedto the locked position. Alternatively, bone screw 206 can be fullyseated in plate hole 204 before locking cap 208 is positioned in track220 and moved to the locked position. Either way, a tool that isconfigured and dimensioned to allow adjustment of the seating of bonescrew 206 with locking cap 208 in position is preferably used.

It will be appreciated by persons skilled in the art that the presentinvention is not limited to what has been particularly shown anddescribed herein above. All references cited herein are expresslyincorporated by reference in their entirety. In addition, unless mentionwas made above to the contrary, it should be noted that all of theaccompanying drawings are not to scale. There are many differentfeatures to the present invention and it is contemplated that thesefeatures may be used together or separately. Thus, the invention shouldnot be limited to any particular combination of features or to aparticular application of the invention. Further, it should beunderstood that variations and modifications within the spirit and scopeof the invention might occur to those skilled in the art to which theinvention pertains. Accordingly, all expedient modifications readilyattainable by one versed in the art from the disclosure set forth hereinthat are within the scope and spirit of the present invention are to beincluded as further embodiments of the present invention.

What is claimed is:
 1. A bone plate fixation system comprising: a boneplate having an upper surface, a bone-contacting surface, and a holedefined by a wall and passing through the upper and bone-contactingsurfaces, the wall including a track; a bone screw having a head and ashaft; and a locking cap having a first tab insertable in the track inan insertion position in which the locking cap can be inserted in avertical direction into the track and movable to a locked position inwhich the locking cap is substantially fixed with respect to the trackin the vertical direction to inhibit back out of the bone screw insertedin the hole, wherein the first tab has an upper surface, a lowersurface, an inner surface in contact with a body of the locking cap, andan outer surface configured to be in contact with the bone plate,wherein the track includes a protrusion and the first tab includes arecess positioned along the outer surface and extending from the uppersurface to the lower surface such that the first tab defines a firstwidth between the inner surface and the outer surface, a second widthbetween the inner surface and the outer surface, and a third widthbetween the inner surface and the outer surface, wherein the secondwidth is positioned between the first width and the third width, and thefirst and third widths are greater than the second width, and in thelocked position, the protrusion engages the recess to preventunintentional movement of the locking cap, wherein the locking cap inthe locked position covers an upper most surface of the head of the bonescrew, wherein the locking cap has an upper surface and the uppersurface of the locking cap is positioned below the upper surface of theplate when the first tab is inserted in the track, and wherein thelocking cap includes a central aperture, the central aperturedimensioned to allow access to the head of the bone screw to allow atool to operatively engage the screw.
 2. The bone plate fixation systemof claim 1, wherein the bone plate includes a first slot extending fromthe upper surface to the track, the first slot configured anddimensioned to receive the first tab such that the locking cap can bemoved from a location external to the bone plate into the track in theinsertion position.
 3. The bone plate fixation system of claim 2,wherein the central aperture is configured and dimensioned to receive atool, the tool operative to move the locking cap between insertion andlocked positions.
 4. The bone plate fixation system of claim 2, whereinthe locking cap has an inferior surface that includes a chamfer thatallows angulation of a screw inserted into the hole at an angle,including an angle other than perpendicular with respect to the boneplate.
 5. The bone plate fixation system of claim 2, wherein the trackextends completely around the wall.
 6. The bone plate fixation system ofclaim 2, wherein the track extends only partially around the wall. 7.The bone plate fixation system of claim 6, wherein the track comprisestwo discrete portions.
 8. The bone plate fixation system of claim 2,wherein the first tab is operatively received in the track such thatwhen the locking cap is moved to the locked position, at least one oftactile, auditory, and visual feedback is provided to indicate that thelocking cap is in the locked position.
 9. The bone plate fixation systemof claim 1, wherein the locking cap has a second tab, opposite the firsttab, and the locking cap has a central longitudinal axis extending fromthe first tab to the second tab and through the central aperture,wherein the recess of the first tab is positioned on the centrallongitudinal axis, and the second tab includes a recess also positionedon the central longitudinal axis.
 10. A method of securing body tissue,the method comprising: providing the bone plate fixation system of claim1; passing the shaft of the bone screw through the hole in an insertiondirection; and attaching the shaft of the bone screw to body tissue byfurther passing the shaft of the bone screw through the hole in theinsertion direction, wherein the locking cap is operatively associatedwith the wall to resist resilient deflection of the locking cap in theinsertion direction of the bone screw less than the locking cap resistsresilient deflection of the locking cap in a direction opposite theinsertion direction.
 11. A bone plate fixation system comprising: a boneplate defining a hole with a track; a bone screw having a head and ashaft; and a locking cap having a first tab insertable in the track,wherein the first tab has an upper surface, a lower surface, an innersurface in contact with a body of the locking cap, and an outer surfaceconfigured to be in contact with the bone plate, wherein the trackincludes a protrusion and the first tab includes a recess positionedalong the outer surface and extending from the upper surface to thelower surface such that the first tab defines a first width between theinner surface and the outer surface, a second width between the innersurface and the outer surface, and a third width between the innersurface and the outer surface, wherein the second width is positionedbetween the first width and the third width, and the first and thirdwidths are greater than the second width, and in a locked position, theprotrusion engages the recess to prevent unintentional movement of thelocking cap, wherein the locking cap in the locked position covers anupper most surface of the head of the bone screw, wherein the lockingcap has an upper surface and the upper surface of the locking cap ispositioned below the upper surface of the plate when the first tab isinserted in the track.
 12. The bone plate fixation system of claim 11,wherein the bone plate includes a first slot extending from the uppersurface to the track, the first slot configured and dimensioned toreceive the first tab such that the locking cap can be moved from alocation external to the bone plate into the track.
 13. The bone platefixation system of claim 12, wherein the locking cap includes a centralaperture, the central aperture dimensioned to allow access to the headof the bone screw to allow a tool to operatively engage the screw, andwherein the central aperture is configured and dimensioned to receive atool, the tool operative to move the locking cap between insertion andlocked positions.
 14. The bone plate fixation system of claim 12,wherein the locking cap has an inferior surface that includes a chamferthat allows angulation of a screw inserted into the hole at an angle,including an angle other than perpendicular with respect to the boneplate.
 15. The bone plate fixation system of claim 12, wherein the trackextends completely around the hole.
 16. The bone plate fixation systemof claim 12, wherein the track extends only partially around the hole.17. The bone plate fixation system of claim 16, wherein the trackcomprises two discrete portions.
 18. The bone plate fixation system ofclaim 12, wherein the first tab is operatively received in the tracksuch that when the locking cap is moved to the locked position, at leastone of tactile, auditory, and visual feedback is provided to indicatethat the locking cap is in the locked position.
 19. The bone platefixation system of claim 13, wherein the locking cap has a second tab,opposite the first tab, and the locking cap has a central longitudinalaxis extending from the first tab to the second tab and through thecentral aperture, wherein the recess of the first tab is positioned onthe central longitudinal axis, and the second tab includes a recess alsopositioned on the central longitudinal axis.
 20. A method of securingbody tissue, the method comprising: providing the bone plate fixationsystem of claim 11; passing the shaft of the bone screw through the holein an insertion direction; and attaching the shaft of the bone screw tobody tissue by further passing the shaft of the bone screw through thehole in the insertion direction.